ENDOCRINE-RELATED ADVERSE EVENTS FROM IMMUNE CHECKPOINT INHIBITORS

Course overview

IMMUNOMODULATORS ARE AGENTS THAT ALTER A PATHWAY CONTROLLING THE ACTIVITY OF THE IMMUNE SYSTEM. IMMUNE CHECKPOINT INHIBITORS ARE IMMUNOTHERAPIES EMPLOYED AS A NOVEL TREATMENT FOR VARIOUS CANCERS, INCLUDING METASTATIC MELANOMA, HODGKIN LYMPHOMA, BREAST CANCER, AND NON-SMALL CELL LUNG CANCER, EACH CARRYING HIGH MORBIDITY AND MORTALITY IN THE SETTING OF LIMITED THERAPEUTIC OPTIONS. DESPITE PROMISING OUTCOMES FOR CANCER TREATMENT, IMMUNE CHECKPOINT INHIBITORS CAN CROSS-REACT WITH CELLS OF THE ENDOCRINE SYSTEM AND POTENTIALLY CAUSE SERIOUS ENDOCRINE IMMUNE-RELATED ADVERSE EVENTS. PATIENTS UNDERGOING TREATMENT WITH IMMUNE CHECKPOINT INHIBITORS MAY DEVELOP VARIOUS ENDOCRINOPATHIES, INCLUDING HYPOPHYSITIS, THYROIDITIS, ADRENAL INSUFFICIENCY, INSULIN-DEPENDENT DIABETES, AND CALCIUM DERANGEMENTS. SPECIFIC AUTOANTIBODIES MAY PLAY A ROLE IN THE SUSCEPTIBILITY OF A PATIENT TO THIS CROSS-REACTIVITY. SPECIALIZED EVALUATION AND MANAGEMENT OF ENDOCRINOPATHIES WITH HORMONE REPLACEMENT THERAPY OR SUPPRESSION IS IMPERATIVE TO GUARANTEE THE BEST POSSIBLE OUTCOMES FOR AFFECTED PATIENTS. LONG-TERM MONITORING AND TREATMENT GUIDED BY AN ENDOCRINOLOGIST IS USUALLY INDICATED.THIS ACTIVITY REVIEWS THE POSSIBLE PATHOPHYSIOLOGY OF IMMUNE CHECKPOINT INHIBITOR-INDUCED ENDOCRINOPATHIES, THE EPIDEMIOLOGY OF THESE ADVERSE EVENTS, AND SPECIFIC EVALUATION AND MANAGEMENT OF THE HORMONAL AXES INVOLVED. THE ACTIVITY ALSO HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL, MULTIDISCIPLINARY TEAM REQUIRED TO CARE FOR PATIENTS WITH IMMUNOMODULATOR-INDUCED ENDOCRINE DISORDERS.